潰瘍瘢痕の内視鏡観察からみた難治性胃潰瘍の特徴と予後

Characteristics and Prognosis of Intractable Gastric Ulcer Determined by Endoscopic Observations of Ulcer Scars

要旨　筆者らは拡大内視鏡観察した瘢痕所見から再発の予測が可能なことを報告してきたが，Sa（中心陥凹あり），Sb（中心まで粗大再生粘膜模様），Sc（周囲同様の微細粘膜模様）の瘢痕分類は通常内視鏡でも判定可能であった．通常内視鏡による2年間の経過観察で，易治性胃潰瘍群33例では67％がSc瘢痕に移行して再発は18％であったのに対し，難治性胃潰瘍群28例では68％がSa瘢痕で経過して再発が71％と高率であった．Ul-Ⅳ潰瘍の特徴である境界明確な顆粒状再生粘膜模様面である瘢痕帯は，易治群18％に対して難治群では71％に認められた．以上の結果より，胃潰瘍の難治性とその易再発性は，組織欠損の深さに起因すると考えられた．

　We have reported that the findings of gastric ulcer scarring by magnification endoscopy can help estimate the likelihood of recurrence of peptic ulcer. Classification of peptic ulcer based on the pattern of regenerative mucosa by ordinary endoscopic examination is as follows: Sa (depression remains in the center), Sb (coarse regenerative mucosal pattern extended to the center), Sc (fine mucosal pattern similar to that in the surrounding tissue).

　In this study, 61 patients with gastric ulcer were followed up prospectively for 2 years. They were divided into tractable and intractable ulcer groups according to the absence or presence of white coating on the ulcer after 8 weeks of treatment. In 33 tractable ulcer cases, 67% of the cases had Sc scar formation and the recurrence rate was 18%. On the other hand, in 28 intractable ones, the scar remained in Sa stage and the recurrence rate was higher (71%). Seventy one percent of intractable ulcer cases, compared with 18% of tractable ones, had a scarring zone which was a well demarcated area with coarse granular regenerative mucosa, specific to Ul-Ⅳ ulcers. These results suggest that intractability and rate of recurrence may be related to the depth of tissue involvement by scar.